Did I do the right thing? - page 2
Hi all, I am a relatively new pediatric nurse. I just have a question about an incident that happened the other night at work. While changing a PICC line dressing on a 1 year old (yes I had help to... Read More
Jun 28, '09Occupation: MICU Joined: Sep '00; Posts: 581; Likes: 164document. thats what nurses do. if you spoke to the er doc and he said " do not use"....write the order. it covers you and it puts the " conflict" where it should belong ...which is between the 2 docs. unless the doc who didnt view the cxr has telepathy....he had no business giving you the ok, unless he had a written hardcopy report from radiology that said it was in an acceptable place.
but...if no hardcopy tenative report was given from radiology....then you did the right thing. i do have a question...why did you contact 2 docs? after you got the order to not use it...you really shoulda stopped there.
drop an email to your boss. tell her as a courtesy you notifid the primary md of the misplacement. and that you felt that you were placed in a disagreement that belonged between the 2 md's.you erred on the side of caution....so....it is ok.omg.....all this drama over a line? dont let them blow this even more out of proportion than it already is. you erred on the side of caution. the only question i have is: most piccs have been primed with heparin after the docs finish placing it. so....it should have been ok even with you not flushing it for one 8 or 12 hour shift.
Jun 28, '09Occupation: MICU Joined: Sep '00; Posts: 581; Likes: 164Quote from mama_dah, the ages old nurse in the middle and getting all the blame scenario.
i would have done the same as you did. i would have probably used the biopatch, although to be honest, if you maintained your sterile field the chances of infection from not using one, especially given that the dressing was likely to be removed in the near future and replaced if the line needed to be advanced, were probably slim.
as far as it not working anymore, was that before or after they tried to manipulate it back into place? if they just left it in the same place, i would suspect that that could be the reason why it wasn't working, given that the ed doc said it was not in proper placement. either way, the doc who actually looked at the cxr for placement is the one whose opinion i would defer to. unless the other doc viewed the film from home before giving the go ahead to use the line...but i would hope he would have told you that he had looked at it before making the decision.
in this situation, it might be in your favor to drop an email or other written account of what occurred to your nm, in an emotionless and factual way. like instead of saying "dr. was angry" put something like "md objected to the decision to not utilize picc line despite prior orders from ed md to not use line until cxr viewed by primary to maintain patient safety secondary to questions regarding placement of picc." be sure, if you do do this, to include all steps that you took regarding the decision and to maintain patient safety in this manner.
ultimately, yes, the kiddo did get another line. however, they also got their abx into them, and in a way in which there was no question as far as delivery into the right place. we are in no position to judge the risk vs. benefit of what the ultimate outcome was, which is why you deferred to a md and then used that information to make your final decision,
and why the docs need to take it up with each other if there's a discrepancy in opinion.
Jun 29, '09Joined: Jun '09; Posts: 14; Likes: 13I didn't mean that the line would be directly in the lung. Isn't a complication of insertion of one of these lines a pneumothorax? So if the lung could be punctured upon insertion, doesn't it also follow that the lung could be affected if the line is moved around after insertion and placement is not verified? If placement isn't verified, isn't 1/2 an inch (for an infant) enough movement for it to possibly be in the vein leading to the lung rather than the superior vena cava?
I've never seen this happen or anything...it just seems like it could happen. Which is why it would be a bad idea to put fluids through that line...unless i'm making ridiculous leaps of logic...but i thought i remembered hearing this stuff in school...
Also, couldn't movement of a PICC cause cardiac arrythmias?